DAURISMO (glasdegib)

DAURISMO (glasdegib)

SELF ADMINISRATION - ORAL

Indications for Prior Authorization:

• Indicated, in combination with a low-dose cytarabine, for the treatment of newly diagnosed acute myeloid leukemia (AML) in adult patients who are ≥ 75 years of age or who have comorbidities that preclude use of intensive induction chemotherapy.

Patients must meet the following criteria for the indication(s) above:

• Patient is ≥ 18 years of age, AND
• Patient meets one of the following:
  • Age ≥ 75 years of age, OR
  • Inability to use  intensive induction chemotherapy supported by medical justification
• Diagnosis of AML confirmed by chart note documentation, AND
• Prescribed by or in consultation with an oncologist or hematologist, AND
• Prescribed in combination with cytarabine

Dosing:

• Oral: 100 mg once daily (in combination with subcutaneous low-dose cytarabine) for a minimum of 6 (28-day) cycles
• Available in 25 mg and 100 mg tablets
• Dose does not exceed 100 mg (1 tab) per day

Approval:

• 1 year